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Evaluation of the underlying causes of papilledema in children
Robert A Hyde1, Mehmet C Mocan2, Urmi Sheth2
1Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois-Chicago, Chicago, Ill..
Insights
Idiopathic intracranial hypertension (IIH) and brain tumors are common causes of papilledema in children. Routine eye exams are recommended for children with craniosynostosis to detect papilledema.
Area of Science:
- Pediatric Ophthalmology
- Pediatric Neurology
- Neuro-oncology
Background:
- Papilledema in children can indicate serious intracranial pathology.
- Identifying the underlying causes of papilledema is crucial for timely diagnosis and management.
Purpose of the Study:
- To determine the types and frequencies of intracranial disorders associated with papilledema in pediatric patients.
Main Methods:
- A retrospective case series was conducted.
- Data from 38 pediatric patients (0-16 years) with papilledema and identified etiologies were analyzed.
- Included demographic data, ophthalmologic findings, and diagnostic work-up results.
Main Results:
- Idiopathic intracranial hypertension (IIH) was the most frequent cause (42.1%), followed by craniosynostosis (18.4%) and intracranial tumors (15.8%).
- Other identified causes included hydrocephalus, transverse sinus thrombosis, hypertensive crisis, subdural hematoma, intracranial abscess, Lyme disease, neurosarcoidosis, and acute disseminated encephalomyelitis.
- Intracranial tumors were equally distributed across sellar/parasellar, posterior fossa, and cortical locations.
Conclusions:
- Clinicians should maintain a high suspicion for IIH and brain tumors in children with papilledema.
- Routine eye examinations are advised for children with craniosynostosis to screen for asymptomatic papilledema.
- Recognizing the spectrum of papilledema etiologies underscores the importance of prompt work-up and consideration of less common causes.
Objective:
The purpose of this retrospective study was to identify the types and relative frequencies of intracranial disorders in pediatric patients who present with papilledema.
Design:
Retrospective case series.
Participants And Methods:
This study was conducted in 2 pediatric ophthalmology clinics, both providing community-based care in a large inner-city urban center in the U.S. Pediatric patients aged between 0 and 16 years diagnosed with papilledema and who had an underlying etiology identified were included in the study. Patient demographic data, ophthalmologic examination findings, and diagnostic work-up results were identified from clinical records.
Results:
The mean age of 38 study patients (19 female, 19 male) was 8.6 ± 4.8 years. Of the 38 patients, 16 (42.1%) had idiopathic intracranial hypertension (IIH) as the underlying cause of the papilledema, 7 (18.4%) had a craniosynostosis disorder, 6 (15.8%) had intracranial tumours, 2 (5.3%) had primary hydrocephalus, and 1 (2.6%) patient each had transverse sinus thrombosis related to sinusitis, hypertensive crisis, subdural hematoma, intracranial abscess, Lyme disease, presumed neurosarcoidosis, and acute disseminated encephalomyelitis. Of the 6 intracranial tumours, 2 (33.3%) presented in the sellar/parasellar region, 2 (33.3%) in the posterior fossa, and 2 (33.3%) were in cortical locations.
Conclusion:
Clinicians should have a high index of suspicion for IIH and brain tumours in children presenting with papilledema. Patients with craniosynostosis should have routine eye examinations to monitor for asymptomatic papilledema. Understanding the relative incidence of etiologies for papilledema highlights the urgency of appropriate work-up and the need to consider low-frequency etiologies.
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